<?xml version="1.0" encoding="UTF-8"?>
<!-- edited with XMLSpy v2016 rel. 3 (x64) (http://www.altova.com) by Mr. Nobody (Altova GmbH) -->
<!-- W3C Schema generated by XMLSpy v2016 rel. 3 (x64) (http://www.altova.com) -->
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema">
	<xs:element name="patient-registration-form">
		<xs:complexType>
			<xs:sequence>
				<xs:element name="practice.name" type="xs:string"/>
				<xs:element name="patient">
					<xs:complexType>
						<xs:sequence>
							<xs:element name="data"/>
							<xs:element name="firstname" type="xs:string"/>
							<xs:element name="lastname" type="xs:string"/>
							<xs:element name="middlename" type="xs:string"/>
							<xs:element name="islegalname" type="yesNoType"/>
							<xs:element name="legalname" type="xs:string"/>
							<xs:element name="formername" type="xs:string"/>
							<xs:element name="birthday"/>
							<xs:element name="age"/>
							<xs:element name="sex" type="sexType"/>
							<xs:element name="married" type="yesOffType"/>
							<xs:element name="parent.guardian.name"/>
							<xs:element name="address"/>
							<xs:element name="home.phone"/>
							<xs:element name="cell.phone"/>
							<xs:element name="social.security.no"/>
							<xs:element name="occupation"/>
						</xs:sequence>
					</xs:complexType>
				</xs:element>
				<xs:element name="employer" type="employerInformation"/>
				<xs:element name="clinicselection">
					<xs:complexType>
						<xs:sequence>
							<xs:element name="choose" type="clinicSelectionType"/>
							<xs:element name="doctorname" type="xs:string"/>
							<xs:element name="familymembers" type="xs:string"/>
						</xs:sequence>
					</xs:complexType>
				</xs:element>
				<xs:element name="insurance">
					<xs:complexType>
						<xs:sequence>
							<xs:element name="owner" type="xs:string"/>
							<xs:element name="birthday" type="xs:string"/>
							<xs:element name="address" type="xs:string"/>
							<xs:element name="homephone" type="xs:string"/>
							<xs:element name="patient" type="yesNoType"/>
							<xs:element name="coveredbyinsurance" type="yesNoType"/>
							<xs:element name="occupation" type="xs:string"/>
							<xs:element name="employer" type="employerInformation"/>
							<xs:element name="primary_insurance">
								<xs:complexType>
									<xs:sequence>
										<xs:element name="insurance_type" type="xs:string"/>
										<xs:element name="subscriber" type="xs:string"/>
										<xs:element name="serial_no" type="xs:string"/>
										<xs:element name="birthday" type="xs:string"/>
										<xs:element name="group_no" type="xs:string"/>
										<xs:element name="policy_no" type="xs:string"/>
										<xs:element name="co_payment" type="xs:string"/>
										<xs:element name="patient_relationship">
											<xs:complexType>
												<xs:sequence>
													<xs:element name="patientrelationship" type="patientRelationshipType" minOccurs="0"/>
													<xs:element name="otherdesc" type="xs:string" minOccurs="0"/>
												</xs:sequence>
											</xs:complexType>
										</xs:element>
									</xs:sequence>
								</xs:complexType>
							</xs:element>
							<xs:element name="secondary_insurance" minOccurs="0">
								<xs:complexType>
									<xs:sequence>
										<xs:element name="insurancename" type="xs:string"/>
										<xs:element name="subscriber" type="xs:string"/>
										<xs:element name="group_no" type="xs:string"/>
										<xs:element name="policy_no" type="xs:string"/>
										<xs:element name="patient_relationship">
											<xs:complexType>
												<xs:sequence>
													<xs:element name="patientrelationship" type="patientRelationshipType" minOccurs="0"/>
													<xs:element name="otherdesc" type="xs:string" minOccurs="0"/>
												</xs:sequence>
											</xs:complexType>
										</xs:element>
									</xs:sequence>
								</xs:complexType>
							</xs:element>
						</xs:sequence>
					</xs:complexType>
				</xs:element>
				<xs:element name="emergency_case">
					<xs:complexType>
						<xs:sequence>
							<xs:element name="targetname" type="xs:string"/>
							<xs:element name="relationship" type="xs:string"/>
							<xs:element name="home.phone" type="xs:string"/>
							<xs:element name="work.phone" type="xs:string" minOccurs="0"/>
						</xs:sequence>
					</xs:complexType>
				</xs:element>
				<xs:element name="emergencyContactForm">
					<xs:complexType>
						<xs:sequence>
							<xs:element name="patientName" type="xs:string"/>
							<xs:element name="parent1" type="parentInfo"/>
							<xs:element name="parent2" type="parentInfo"/>
							<xs:element name="emergencyContact1" type="emergencyContact"/>
							<xs:element name="emergencyContact2" type="emergencyContact"/>
							<xs:element name="medicalInfo" type="medicalInformation"/>
						</xs:sequence>
					</xs:complexType>
				</xs:element>
			</xs:sequence>
		</xs:complexType>
	</xs:element>
	<xs:complexType name="parentInfo">
		<xs:sequence>
			<xs:element name="name" type="xs:string"/>
			<xs:element name="home.phone" type="xs:string"/>
			<xs:element name="work.phone" type="xs:string" minOccurs="0"/>
			<xs:element name="address" type="xs:string"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="emergencyContact">
		<xs:sequence>
			<xs:element name="contact" type="xs:string"/>
			<xs:element name="home.phone" type="xs:string"/>
			<xs:element name="work.phone" type="xs:string" minOccurs="0"/>
			<xs:element name="address" type="xs:string"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="medicalInformation">
		<xs:sequence>
			<xs:element name="preference" type="xs:string"/>
			<xs:element name="physicianName" type="xs:string"/>
			<xs:element name="sex" type="sexType"/>
			<xs:element name="phoneNo" type="xs:string"/>
			<xs:element name="insuranceCompanyName" type="xs:string"/>
			<xs:element name="policyNo" type="xs:string"/>
			<xs:element name="specialConsiderations" type="xs:string"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="employerInformation">
		<xs:sequence>
			<xs:element name="name" type="xs:string"/>
			<xs:element name="address" type="xs:string"/>
			<xs:element name="phone" type="xs:string"/>
		</xs:sequence>
	</xs:complexType>
	<xs:simpleType name="yesNoType">
		<xs:restriction base="xs:string">
			<xs:enumeration value="yes"/>
			<xs:enumeration value="no"/>
			<xs:enumeration value=""/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="yesOffType">
		<xs:restriction base="xs:string">
			<xs:enumeration value="Yes"/>
			<xs:enumeration value="Off"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="clinicSelectionType">
		<xs:restriction base="xs:string">
			<xs:enumeration value="doctorName"/>
			<xs:enumeration value="hospital"/>
			<xs:enumeration value="yellowPages"/>
			<xs:enumeration value="insurancePlan"/>
			<xs:enumeration value="closeToHome"/>
			<xs:enumeration value="friend"/>
			<xs:enumeration value="other0"/>
			<xs:enumeration value=""/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="sexType">
		<xs:restriction base="xs:string">
			<xs:enumeration value="male"/>
			<xs:enumeration value="female"/>
			<xs:enumeration value=""/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="patientRelationshipType">
		<xs:restriction base="xs:string">
			<xs:enumeration value="self"/>
			<xs:enumeration value="spouse"/>
			<xs:enumeration value="child"/>
			<xs:enumeration value="other"/>
			<xs:enumeration value=""/>
		</xs:restriction>
	</xs:simpleType>
</xs:schema>
